HEALTH EXCHANGE – Lawmakers (from left) Cleon Turner, Sarah Peake and Dan Wolf speak with Cape business leaders at a legislative breakfast at the Wequassett Inn in Harwich April 8.

Legislators meet with Cape business leaders

Speaking to a group of Lower Cape business leaders April 8 in his hometown, state Sen. Dan Wolf wasn't sheepish in expressing his views about health care.

“How do we get the ball and chain of medical care off of the back of business?” the Harwich Democrat asked a breakfast meeting sponsored by the Harwich Chamber of Commerce. While a real comprehensive health care reform must be done carefully, “there is no in between,” he said.“Either it stays where it is and becomes more of a drain” on small businesses, or health insurance moves toward a new model. While Wolf was reluctant to say what model he prefers, “by process of elimination you quickly get to where I think it needs to be,” he said. Wolf is a member of the Legislature’s joint committee on health care financing.

In the past, insurance companies existed with the goal of providing their clients with security and safety, based on the use of a pool of contributed money. Now, Wolf said, “when we cross the line into insurance companies becoming investment vehicles,” and those companies are required to produce a return on their investments, “we cross the line from sanity and rational thinking into insanity.”

The problems aren't limited to health insurance companies, he said.Property insurers can provide figures that explain why homeowners' policies are so expensive, but “they don't add up. There's a real problem with what we're paying and what the real risk is,” Wolf said.

Increasingly, everyone agrees that the current system of health insurance is seriously flawed, he argued. “I think the business community really needs to unify around a message on this,” Wolf said. “Let's get behind decoupling it from employment.” Health care providers increasingly agree that a simpler, more centralized claims system would save money and effort, according to Wolf.

“I think we're following the target up in Boston,” the senator said. Governor Deval Patrick has filed a 54-page bill that would set up “accountable care organizations,” or groups of health care providers that join as legal entities to help reduce the cost and improve the quality of health care for their patients. Federal law passed in 2009 calls for accountable care organizations in Medicare and Medicaid, and rewards them with a share of the cost savings if they meet benchmarks in health care quality. A key strategy is to move away from the current fee-for-service model.

“But it's still not going to have addressed the major problem,” Wolf said, namely that “middlemen” are not good advocates for affordable, quality health care. He urged chambers of commerce to try to find some consensus of opinion among their members, and then make their voices heard in the health care debate.

Harwich real estate broker Richard Waystack said that, while small businesses are hugely important to the economy, they aren't the only employers who would be affected by such a change.

“The unions need to be part of that discussion,” he said.If steps are taken to decouple health care from employment, “all of those players need to be sitting together to talk about it.” Local municipal employees would certainly want a seat at that table, he added.

State Rep. Cleon Turner, D-Dennis, said the reason the state's last health care reform effort fell short is that it failed to adequately regulate the insurance industry. Turner said Patrick attended a recent meeting at Cape Cod Hospital, and was surprised to learn that health care providers weren't seeing any real increase in payments from insurance companies.

“The governor was talking about things that were done to lower the costs for the insurance industry, expecting that those [savings] would be passed on to the medical industry,” Turner said. It is wise to work toward a single-payer model, but in the meantime, the insurance companies shouldn't be allowed to pocket the savings from reforms, he argued.

State Rep. Sarah Peake, D-Provincetown, warned against the unintended consequences of reining in the cost of private insurance, which plays a key role in helping Cape Cod Hospital provide affordable care. The hospital depends on private insurance reimbursements as an important profit center, she noted. As an example, Blue Cross Blue Shield recently listed Cape Cod Hospital as a “Tier 2” provider, and employers pay an additional $1,000 a year to allow their workers to have elective surgery there, instead of traveling off-Cape to Jordan Hospital, which is more affordable. “That's just crazy on any number of levels,” Peake said.